睡眠窒息症的手術種類 (上)

大部份患上睡眠窒息症的以中年男性及肥胖人士居多，患者通常會出現黑眼圈、疲累、說話時鼻音較重，甚至要用口呼吸等情況。 很多時，患者是因其伴侶受不了他們的困擾才到來求診。 經確診後，一般均發現有睡眠窒息症的病徵如疲倦、大鼻鼾聲、睡中驚醒、記憶力衰退及鼻喉有阻塞等。
 
過往有不少患者不欲求診，主因是抗拒長期要帶呼吸機。其實，有些患者經醫生診症後，可以手術令病情有較持久的改善，藉此避免長期使用呼吸機的不便。當然，不是所有患者都可以手術達致理想的治療效果，特別是超重者 (BMI體重指標值大於25)，醫生會建議病人在手術前要先減肥，因肥胖人士體內組織較鬆弛，而手術過程需要把呼吸道打開或把一些組織拉緊，在此情況下，肥胖患者便可能得不到最佳手術效果，甚至令復發率提高。因此減肥是治療過程的重要一環。
 
以下幾種情況都適合進行手術治療: 

1.     大部分兒童患者。他們普遍都有兩、三個阻塞的部位，包括扁桃腺、腺樣體及下鼻甲鼻膜增生。前兩種是最常出現於兒童患者身上，可通過扁桃腺切除(Tonsillectomy)及腺樣體切除(Adenoidectomy)。 隨著近幾年空氣變差，越來越多病人患有鼻膜增生的情況，可以手術將下鼻甲骨外的鼻膜縮小(Inferior Turbinate Reduction)。這三種阻塞位置都是兒童身上最常見，令其患上睡眠窒息症。

 

2.     患有鼻塞的人士: 如鼻中隔骨不正(Deviated Nasal Septum)、鼻膜脹大、有鼻息肉(Nasal Polyp)，都可透過手術改善。

 

3.     舌頭出現問題: 特別是下巴較短人士。 因舌頭與下巴骨相連，當患者睡覺時，舌頭位置較後而出現向後塌下，引致呼吸阻塞，可透過手術來改善舌頭問題。

 

4.     面部骨骼問題: 如整個中面凹入或下半面部下陷的人士，患有一些影響面部的綜合症的兒童或面部骨架有缺憾的年輕人士都適合做手術。

 

先說鼻部手術，常見有鼻中隔矯形手術(Septoplasty)，另外是鼻甲骨減細手術(Turbinate reduction)。就算是肥胖患者因鼻問題而引致阻塞，亦適合以此手術治療。 鼻部手術可令鼻呼吸暢通，達致兩個效果。



資料來源:  信報
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的耳鼻喉專科醫生查詢，而不應單倚賴以上提供的資料。 

「面癱」的診斷及治療

診斷方面，可分為急性、半急性及非急性情況。急性的情況是突然發生的面部神經麻痺，患者是會即時發覺的，初次病患者大多數屬於這種情況。

急性「面癱」又分爲外科性(Surgical)及內科性(Medical)兩類。可以用手術治療的，是外科性的「面癱」。至於內科性的「面癱」，最常見是由病毒引致面部神經出現問題。大部分病患者向專科醫生求診後，憑臨床診斷已可以知道是什麽原因。但有些特殊情況，例如復發性(Recurrent)面癱，即以前已服藥痊癒，但過了一段時間，又再出現同樣情況，就要做磁力共振檢查(Magnetic Resonance Imaging – MRI)，看看有沒有患上面部神經線腫瘤(Facial Nerve Tumour)。

治療方面，最重要是儘早求醫。例如最常見的貝耳氏面神經麻痺，超過八成患者都可以有良好恢復，超過七成患者甚至可完全康復。醫學研究證實最重要的藥物是口服的類固醇(Oral Prednisolone)，而抗病毒藥物(Acyclovir, Famciclovir)也對病情有幫助，通常與類固醇一同使用。

除了藥物治療，有需要時也要保護眼睛。原來面部神經有一條分枝是負責眼睛閉合。如果右邊面部麻痺，右邊眼睛便不能閉上。在日間要保護眼睛，可用滋潤性的眼藥水，晚上睡覺時則於眼睛塗上滋潤性的眼藥膏，並用紗布蓋著眼皮。如保護眼睛不足，嚴重者可引致暴露性角膜炎 (Exposure Keratitis)，甚至可以影響視力。

過了一年後，如果還未完全康復，就會進入非急性「面癱」的情況。患者可能需要接受面部肌電圖測試(Facial Electromyography)，以電力測試患者的面部肌肉功能。如面部肌肉正常，我們可以舌頭神經(Hypoglossal Nerve)或另一邊面部正常的神經(Cross-Facial Nerve Graft)接駁面部受損的神經，從而恢復控制面部肌肉的能力。若肌電圖顯示面部功能未能恢復，便有可能需要進行靜態的面部重建手術，如鉑金植入手術(Platinum Lid Chain)、拉面皮手術(Face Lift)、顳肌轉移手術(Temporalis Muscle Transfer)等。然而，手術後還需要配合物理治療，要數月至一兩年後才能康復。

最後再提醒大家，若發現有急性「面癱」的情況出現時，應儘快向醫生求診，因愈早接受治療，康復機會愈大。




資料來源:  信報
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的耳鼻喉專科醫生查詢，而不應單倚賴以上提供的資料。

耳部損傷及處理方法 (下)

當遇到極大的撞擊(如車禍或嚴重意外)，除了會令耳膜破損外，耳骨(Ossicles)亦有機會受到影響。我們的中耳內共有三個互相連接的耳骨，以幫助聲音傳入內耳。巨大的撞擊會使耳骨移位或碎裂，導致傳導性失聰(Conductive Hearing Loss)，情況較耳膜穿孔更嚴重。在這些情況下，便有需要做耳骨重整手術(Ossiculoplasty)。醫生會透過此手術將病人的耳骨移正，並且在耳骨嚴重受傷，不能修復的情況下，使用人工耳骨代替原來的耳骨，藉此收復耳骨聲音的傳遞鏈。除上述外，中耳內部其他組織亦有機會在撞擊意外中受到影響，如面部神經線可以斷裂或腫脹，造成暫時或永久性面癱(Facial Nerve Palsy)。


耳部損傷以內耳損傷最為嚴重，如上文提及，內耳是由耳蝸(Cochlea)、三個半規管(Semicircular Canals)等組成，內藏耳水。耳水受到聲音振動通過内耳神經細胞轉換成「電能」，再通過神經線傳至腦部。在頭骨受到猛烈撞擊下，可導致顳骨骨折(Temporal Bone Fracture)。這個時候， 耳水便有機會從内耳流出(Perilymph Fistula)，導致神經線性失聰(Sensorineural Hearing Loss)和眩暈(Vertigo)。透過電腦掃描檢查，便可以確定顳骨有否出現裂痕，而這些裂痕有沒有跨越内耳。

除了受到外來撞擊，有時候受到其他壓力影響(如潛水)，或自身中耳壓力增加(如猛烈咳嗽)的時候，耳水也有機會流出來。若有此情況，醫生會為患者作聽覺檢查(Pure Tone Audiogram)及眼振電圖檢查(Electronystagmography)。若確定耳水流出，可用保守性的治療方法，即透過休息、頭仰起30度及用鎮靜藥物使耳朵減低受壓。若情況仍未有改善，患者便需要進行手術，以脂肪(Fat Plug)阻塞流出耳水的地方及連接內耳及中耳的部位，以防止耳水流出，患者於成功治療後頭暈及聽力減退的情況應會收到控制。




資料來源:  信報
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的耳鼻喉專科醫生查詢，而不應單倚賴以上提供的資料。

耳部損傷及處理方法 (上)

耳朵的構造，主要分為三部分－外耳、中耳及內耳。外耳包括耳殼及耳道(即由耳孔至耳膜，而耳膜是外耳與中耳的分界線)。中耳則由耳膜至耳蝸外的鐙骨，內有不同組織，包括三塊聽小骨、面部神經線和耳咽管(通往鼻咽的管道，以平衡中耳壓力)。至於內耳，它是由耳蝸、三個半規管、內耳神經線及內耳管組成，內耳後方便是腦部位置。


耳殼是外耳最常受傷的部位。若受傷的情況屬於輕微(如皮膚輕微擦損等)，傷者可自行用消毒藥水及消毒藥膏處理。可是，如情況嚴重時，例如被利器刺傷(如剪刀)或因撞擊而導致撕裂等，便應立即求醫。我們耳殼皮膚下緊貼著軟骨膜 (Perichondrium) 及軟骨 (Cartilage)，因此當被割傷或撕裂時，往往會使軟骨暴露在外，若沒有及時處理而受到細菌感染，便會引致軟骨或軟骨膜發炎，嚴重者可令軟骨及耳殼變形，影響外觀。因此，當遇上述情況應立即求醫，醫生一般會於傷口縫針以避免細菌感染及發炎的情況發生。


耳殼如多次受到撞擊(Blunt Injury)亦會導致耳殼水腫(Seroma)或積聚瘀血(Haematoma)等情況，例如會見於職業拳擊手或欖球員身上。耳殼水腫是累積的，當耳受到撞擊時，水分便由血管慢慢滲出，日積月累耳朵位置會像水泡一樣的腫脹起來。由於它在慢性的情況下發生，所以患者通常不會感到痛楚。處理方法可用針筒抽走水腫。若再復發，可在其位置開小切口讓水分全部流出，隨後以繃帶按緊，再以外包紗布或縫上棉條固定於耳殼上，使它在壓力下不容易復發。


若耳內積聚瘀血，患者表面上是沒有明顯的損傷或裂開，但瘀血會即時從軟骨膜上的血管渗出，流到軟骨膜及軟骨之間，使周邊因而腫脹。它屬於急性情況，若不及時處理有機會導致發炎或令耳朵變形。治療方法跟內積水一樣，此外醫生亦會以抗生素避免患處發炎。





 資料來源:  信報
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的耳鼻喉專科醫生查詢，而不應單倚賴以上提供的資料。

The Cochlear™ baha® hearing system

The Cochlear™ baha® ( bone anchored hearing aid ) sound processor system has been successfully used to treat specific hearing conditions in Hong Kong since 1996. The technology translates sounds from a hearing processor, through a titanium implant, to the cochlea or inner ear. The vibrations received are perceived as sounds, and the patient “hears”.

Today, for the surgeon and the baha client, this simply translates to a direct bone conduction hearing system that is:

• surgically simpler with the Hong Kong incision,
• faster with single stage surgery,
• earlier for baha use with improved implant coating technology and design, and
• higher in fidelity hearing performance with the latest series of digitally programmable hearing processing systems.

                
Currently the indications by clinical condition for the baha hearing system include any of the following:

Conductive hearing losses e.g. congenital aural atresia, mastoidectomies
Mixed hearing losses e.g. post-irradiated nasopharyngeal cancer patients with hearing difficulties
One-sided total hearing losses ( or medically, single sided deafness, SSD)

How do we know if a patient will benefit from the baha processor. Simply we let them try it with a softband. If they like it, they are potential candidates for….

the only hearing implant system that “you can try before you buy”.
The Cochlear™ baha®  hearing system…..now, how much easier can it be!



Dr Gordon Soo, MD







Reference: www.entific.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

Sinus and nose-related headaches – Treatment

These include causes such as:
·    nose allergy,
·    a bent nasal septum blocking the sinus opening or in contact with the opposite nasal lining,
·    a narrowed sinus opening/s with a sinus infection and
·    an obstructed sinus with a negative sinus pressure
Sometimes possibly all of the above can be present in the same person at the same time. All of these conditions can stimulate and irritate the trigeminal nerve, which then generates the headache that we feel.

Treatment begins with the correct diagnosis. A full external and internal endoscopic examination of the nose should be undertaken. In instances when a sinus-related cause is suspected e.g. facial pains above, behind and below the eyes, and at the top of the head, a CT scan of the sinuses can exclude sinus disease. X-ray of the sinuses are traditionally undertaken but for a more comprehensive picture, CT scans provide a great deal more information as well as serve as the roadmap for sinus surgery should that be required.

Usually common things happen commonly, and by far the commonest nasal cause of a headache is inflammation of allergy or infection. If infection is seen, a simple course of antibiotics can be undertaken. Nasal allergy is easily treated also by avoiding the allergen e.g. house dust or pollen, saline nasal irrigation, topical nasal steroids and/or antihistamines. The reduction in the inflammation desensitizes the nasal lining as well as reduces the possibility of nasal lining contact and sinus obstruction.

Perhaps the next most likely cause for nasal irritation is when two opposing nasal linings touch one another forming a trigger point. This is likely to occur when the nasal septum is bent inside the nose. Often the patient would be aware of the bent septum as they are aware of a blocked nose, more on one side than the other although both may be equally blocked.

Sometimes a frank sinus infection is seen on endoscopy. Then antibiotic treatment with nasal decongestants also, would normally suffice, as sinus surgery is not the usual first line treatment modality. However in situations when the sinus condition becomes chronic without relenting or recurrent, then usually a more permanent solution to re-open the sinus drainage and re-vent the sinuses may be indicated. Nowadays, sinus surgery is extremely high tech, using endoscopes for minimally invasive surgery. Surgery is targeted at re-opening the natural openings of the sinuses. To make the surgery even less traumatic, when appropriate, the sinus openings can be re-dilated with inflatable balloons; this technique is known as balloon sinuplasty.

So to summarize, nose and sinus-related headaches are not altogether that uncommon especially today in our polluted modern world. It should be differentiated from all the other causes of headaches by its picture. Treatment of these headaches are usually very successful once the correct diagnosis has been established, as there is often a triggering point that fires off the nerve-endings of the trigeminal nerve that gives us these so-called Sluder’s headaches. You can almost imagine Dr. Sluder himself having a bad headache when he first described it too!




Reference: www.entific.com.hk/headache-remedy.html
The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

Sinus and nose-related headaches – Why? & Causes

Headaches! We have all had them. There are many causes of headaches but this article relates to that arising from conditions that affect the nose and sinuses. Our nose is very sensitive. It has to be as it forms one of our earliest sense organ for finding food as well as arousing us to the presence of danger from predators or our changing environment. Many of us know the nose as an organ of smell (and therefore flavor) and this sensation comes from the olfactory nerve. The nose however has another nerve supply that provides us with the sensation of heat, cold, dry, humid and of course, pain. This sensation arises from the fifth nerve of our brain called the trigeminal nerve.

You all know this nerve, which innervates your face, eyes, nose, sinuses and teeth. It burns and gives you a headache if you do somersaults underwater in the swimming pool or take too much wasabi on your sushi. Your face burns from the inside and your eyes water. This is when your trigeminal nerve is being hyper-stimulated.

This same nerve is responsible for the headaches one can get from sino-nasal disease. If someone has nasal allergy, and especially if the septum (the bone inside your nose that separates the right from the left nostril) is bent, the lining of the nose expands considerably. When the hypersensitive linings touches one another, they can cause a localized headache at the top of the head, the temples or the back of the head. This kind of headache, or nerve pain, is known as Sluder’s neuralgia or Sluder’s headache.

Our sinuses are air-filled cavities inside our skull. These cavities have very narrow openings into the nose. Again, due to:

·             a nose allergy,

·             a bent septum blocking the sinus opening,

·             a narrowed sinus opening/s from recurrent infection

·             or all of the above in the same person at the same time,

the sinus opening/s become blocked. When this happens, a negative pressure is generated within the sinus and this can cause facial pains and headaches. If, on the other hand, there is a bacterial infection with pus formation, the pus will build up an intense pressure from within the sinus causing pain too. This change in pressure stimulates the nerve endings in the nose and sinuses, causing a sinus headache.

If only specific sinuses are affected like the frontal sinuses above the eyes, then a headache above and behind the eye may be felt.  Sinus headaches are peculiar in that the pain changes in intensity with position, being usually more painful when the head is lowered i.e. tying the shoelaces or picking something from the floor. Also the bony surface of the face just outside the inflamed sinus is painful to applied pressure from outside the face.

Naturally, as you now understand that sino-nasal inflammation can cause headaches, you will realize that any infection of the inside of the nose can do this too. Even when we are stressed, the nose lining inside swells up and this can manifest as a headache. Equally cancers of the nose, sinuses and nasopharynx can cause headaches as they stimulate the trigeminal nerve or block the sinus openings. Cancers are thankfully much, much less common than allergies. However in any case, any persistent or recurring headaches is best investigated for its cause and the correct treatment offered.

Reference: www.entific.com.hk/headache.html

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.